74 DISEASES OF T1IE TRACHEA AND BRONCHI. 



tensity. The most violent distress arises from that form of the disease 

 in which a gray tenacious secretion lies upon the mucous membrane, 

 which is particularly swollen in such cases, while chronic bronchia 

 catarrh, with more copious and more liquid yellow secretion, occasions 

 comparatively slight trouble. In the former variety (catarrh sec of 

 Laennec), it is the protracted and tormenting coughing-spells (due to 

 the toughness of the secretion, and its situation in the smaller bronchial 

 tubes) which are the chief source of suffering to the patient. During 

 these paroxysms of coughing, the interruption to the current of the 

 jugulars causes them to swell greatly, the countenance becomes dark- 

 red and bluish, the eyes weep, the nose drips, kC the head seems as if 

 about to split," and is spasmodically grasped by the patient with both 

 hands. Not unfrequently the veins, distended by constant coughing-fits, 

 remain varicose, even where there is no emphysema, and thick blue ves- 

 sels show themselves on the cheek and alae nasi. An attack of cough- 

 ing, of great violence, frequently terminates in retching or vomiting, 

 the contents of the stomach being pressed out by the contracted ab- 

 dominal muscles. 



Permanent dyspnoea is much more common in this disease than in 

 acute catarrh, since in this the mucous membrane is more thickened and 

 swollen, and thus offers greater impediment to the entrance of air. 

 When, as often happens, an acute attack of bronchial irritation sets in 

 upon a chronic catarrh, the dyspnoea becomes much aggravated, the 

 affection receives the name of humid asthma. After a short walk in a 

 cold, dry atmosphere, which seems particularly hurtful to such invalids, 

 they often remain for weeks in the most miserable condition, obh'ged 

 constantly to sit upright, and to pass even the entire night in an arm- 

 chair, in order to aid the expansion of the chest as much as possible. 



In consequence of the dyspnoea and of the continuous and im- 

 moderate exertion of the inspiratory muscles induced by it, the latter 

 become hypertrophied. This hypertrophy is most marked in the sterno- 

 cleido-mastoid muscles and in the scaleni, which stand out upon the 

 neck like strong cords. Like other hypertrophied muscles, those of the 

 respiratory apparatus are constantly in a condition of moderate contrac- 

 tion ; and (just as locksmiths or blacksmiths and the like habitually 

 carry their arms slightly flexed, instead of letting them hang loosely), 

 so in chronic bronchial catarrh, the chest is as it were drawn up toward 

 the head by these muscles. The neck seems shorter and thicker, the 

 chest more convex ; but we are not warranted in diagnosticating the 

 complication of emphysema of the lungs from these symptoms alone, 

 although the complication is common enough. 



Sometimes, during long-protracted and severe exacerbations of bron- 

 chial catarrh, the jugular veins become distended, cyanosis appears, and 



